93 Decision Citation: BVA 93-17374
Y93
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 93-04 765 ) DATE
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THE ISSUE
Entitlement to an increased evaluation for service-connected
residuals of a partial removal of the right wrist navicular,
currently rated as 20 percent disabling.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
The appellant
ATTORNEY FOR THE BOARD
Lisa K. Holliday
INTRODUCTION
This matter came before the Board of Veterans' Appeals (Board) on
appeal from a March 1992, rating decision of the St. Petersburg,
Florida, Regional Office (RO), which denied an increase in the
disability rating for the veteran's right wrist disorder, currently
rated as 20 percent disabling. The notice of disagreement as to this
decision was received on March 30, 1992. A statement of the case was
issued on May 7, 1992, and the substantive appeal was received on June
23, 1992. Supplemental statements of the case were issued on
September 15, 1992, and January 8, 1993.
A personal hearing on appeal was held on February 25, 1993, in St.
Petersburg, Florida, before Jack W. Blasingame, who is the Chief
Member of the Board section rendering the final determination in this
claim and was designated by the Chairman to conduct that hearing,
pursuant to 38 U.S.C.A. § 7102(b) (West 1991).
The appeal was received at the Board on March 3, 1993, and docketed
the next day. The veteran has been represented during his appeal by
the Disabled American Veterans. This case is now ready for appellate
review.
The veteran had active service from April 1942 to February 1945.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends that he currently experiences severe pain as a
result of service-connected residuals of a partial removal of his
right wrist navicular. He maintains that he must take several
medications because of this disability and complains that as a result
of his wrist disorder, he can no longer bowl, fish, play golf, or even
write a letter.
DECISION OF THE BOARD
In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991),
following review and consideration of all evidence and material of
record in the veteran's claims file, and for the following reasons and
bases, it is the decision of the Board that the preponderance of the
evidence is against the claim for an increased evaluation for service-
connected residuals of a partial removal of the right wrist navicular.
FINDINGS OF FACT
1. The veteran's right hand is his major hand.
2. The veteran's right wrist disorder is manifested currently by
pain, swelling, tenderness, and severely limited wrist palmar and
dorsiflexion, but with full pronation and supination ability.
3. The impairment contemplated by the veteran's existing disorder is
properly compensated for by the rating currently in effect.
CONCLUSION OF LAW
The schedular criteria for an increased disability evaluation for
service-connected residuals of the partial removal of the right wrist
navicular have not been met. 38 U.S.C.A. § 1155 (West 1991);
38 C.F.R. Part 4, Codes 5213, 5214, 5215 (1992).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
We note that we have found that the veteran's claim is "well-grounded"
within the meaning of 38 U.S.C.A. § 5107 (West 1991), effective on and
after September 1, 1989. That is, we find that he has presented a
claim which is plausible. We are also satisfied that all relevant
facts have been properly developed. There is no indication that there
are additional records which are obtainable. No further assistance to
the veteran is required to comply with the duty to assist him as
mandated by 38 U.S.C.A. § 5107(a) (West 1991).
The veteran had active service from April 1942 to February 1945.
Service connection is in effect for residuals of the partial removal
of a right wrist navicular, for which the RO has assigned a 20 percent
evaluation under the provisions of Diagnostic Codes 5213, 5214, and
5215 of the Department of Veterans Affairs (VA's) Schedule for Rating
Disabilities, 38 C.F.R. Part 4 (1992). This evaluation has been in
effect since June 23, 1945.
Pursuant to one of the disability codes under which the veteran's
wrist disorder has been rated, a ten percent disability evaluation is
warranted for limitation of wrist supination to 30 degrees or less. A
20 percent rating is warranted for limitation of pronation with motion
lost beyond the last quarter of the arc, and a 30 percent rating is
merited for limited pronation with loss of motion beyond the middle of
the arc. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Code 5213
(1992).
For favorable ankylosis of the wrist in 20 to 30 degree dorsiflexion,
a 30 percent evaluation is warranted. For ankylosis of the wrist in
any position except favorable, a 40 percent rating is merited.
38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Codes 5214 (1992).
For palmar flexion of the wrist limited in line with the forearm or
for dorsiflexion limited to less than 15 degrees, a 10 percent
6valuation is warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F. Part
4, Code 5215 (1992).
The recent evidence of record includes a VA examination from January
1992, and private treatment records and physician's reports from 1992
and 1993.
During a January 1992 VA examination, the veteran complained of pain,
swelling, and stiffness in his right wrist. On examination, the
veteran had full pronation and supination of the forearm. Wrist
flexion was to 60 degrees, and extension was to zero degrees. He had
ulnar deviation of 15 degrees and radial deviation of 3 degrees.
There was soft swelling on the dorsum of the wrist measuring
approximately 2 by 2 centimeters, which was raised up off the surface
of the wrist approximately 1 1/2 centimeters, and was minimally tender
to deep palpation. There was some atrophy in the thenar and
hypothenar eminence, but there appeared to be adequate circulation in
all fingers. X-rays revealed severe degenerative changes with
obliteration of the jointlines between all of the carpus and the
carpus radial and carpometacarpal joints, and a severely decompensated
wrist. It was indicated that, as a result of the veteran's wrist
disability, he was unable to fish or play golf. It was also noted
that he was not taking any medication for his disorder.
In May 1992, the veteran underwent an examination by a private
physician. Orthopedic examination of the right wrist revealed marked
limitation of motion in both dorsi, with palmar flexion, radial and
ulnar deviation to approximately 10 to 15 degrees with pain. There
was a dorsal callous on the top of the wrist and marked swelling and
tenderness. The palmar aspect of the right hand revealed evidence of
thenar atrophy, some decreased sensation in the median nerve
distribution, and limitation of motion. There was also a healed
surgical scar from his prior surgery. X-rays of the wrist showed
marked advanced degenerative intercarpal arthritis, radial arthritis,
subchondral cyst formation, and loss of the normal architecture. The
examiner's impression was that the veteran suffered from advanced
degenerative arthritis, post traumatic in nature, and carpal tunnel
syndrome of the right wrist with advanced findings. He was referred
to a hand specialist for further evaluation and treatment.
During a private evaluation in October 1992, it was indicated that the
veteran had approximately 25 to 35 degrees of wrist palmar flexion,
with no dorsiflexion. It was also indicated that he had full
supination and full pronation. An old scar was noted from an old
carpal tunnel release that was performed in 1983, which was noted as
having nothing to do with the destruction of the wrist. Finger
flexion was excellent, with good thumb abduction and opposition, but
with slight weakness of the opponens probably due to the carpal tunnel
which was not related to the wrist problem. X-rays revealed complete
destruction of the radiocarpal joint and the midcarpal joint with
complete collapse of the carpal area. There was destruction of the
entire scapholunate triquetrum pisiform and the radiocarpal and carpal
joints with slight radial deviation, a flexion deformity, and a lot of
osteophytes on the dorsum of the wrist (that explains that lump the
veteran has there). This disability was noted as being painful ,
especially with any attempt to increase the flexion or dorsiflexion
passively. It was the examiner's opinion that wrist fusion would be
the only surgical possibility for relieving the veteran's problem.
Additional evidence in the file includes the transcript of a February
1993 hearing on appeal conducted in St. Petersburg, Florida, by the
Chief Member of the Board section rendering the final determination in
this claim. At this hearing, the veteran testified that he suffered
from much pain and swelling in his right wrist. He acknowledged that
surgical fusion was probably necessary to alleviate the pain, but
expressed concern about possible side effects of surgery, such as
nerve damage and the loss of mobility of his fingers. He also
indicated that, but for his wrist problem, he could have returned to
his prior occupation (scrap metal) and have become a millionaire
today.
Based on the foregoing evidence, it is our opinion that the veteran's
right wrist disorder does not merit an increased evaluation. The most
recent medical findings revealed full pronation and supination ability
in his right wrist. Therefore, an increased evaluation pursuant to
Diagnostic Code 5213 (dealing with impairment of pronation and
supination) is not applicable here. In addition, medical findings
failed to demonstrate evidence of right wrist ankylosis such as to
warrant a higher evaluation under Code 5214. Current medical findings
revealed severe limitation of flexion with pain, swelling, and
tenderness. Arthritic changes in the wrist were also shown, although
these had been present for many years. Diagnostic Code 5215 provides
for a maximum evaluation of 10 percent for limitation of motion (both
palmar and dorsiflexion) in the wrist. The 20 percent disability
rating of which the veteran is currently in receipt exceeds the
maximum rating under Code 5215. This grant of benefits, however, has
been in effect for over 20 years and is thus considered a protected
rating pursuant to 38 C.F.R. 3.951 (1992).
Additionally, we do not believe that increased compensation under 38
C.F.R. § 4.10 (1992) is warranted since it has not been shown that the
effects of the veteran's wrist disability are so severe as to render
him unable to function under the conditions of daily life. While
taking into account the fact that bowling, playing golf and fishing
were apparently normal daily activities in the appellant's life, we do
not consider the negative effects his wrist disability apparently had
on these activities meritous of additional VA compensation.
Accordingly, it is our opinion that the current rating provides
appropriate compensation for the veteran's disability and its current
symptomatology. This decision does not preclude him from reopening
his claim in the future should symptoms increase in severity.
ORDER
An increased evaluation for service-connected residuals of a partial
removal of the right wrist navicular is denied.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
W. H. YEAGER, M.D.
JACK W. BLASINGAME
*38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans'
Appeals Section, upon direction of the Chairman of the Board, to
proceed with the transaction of business without awaiting assignment
of an additional member to the Section when the Section is composed
of fewer than three Members due to absence of a Member, vacancy on
the Board or inability of the Member assigned to the Section to serve
on the panel. The Chairman has directed that the Section proceed
with the transaction of business, including the issuance of
decisions, without awaiting the assignment of a third Member.
(Continued on next page)
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a
decision of the Board of Veterans' Appeals granting less than the
complete benefit, or benefits, sought on appeal is appealable to the
United States Court of Veterans Appeals within 120 days from the date
of mailing of notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board was filed
with the agency of original jurisdiction on or after November 18, 1988
(see sec. 402 of the Veterans' Judicial Review Act (Pub. L. 100-687)).
The date which appears on the face of this decision constitutes the
date of mailing and the copy of this decision which you have received
is your notice of the action taken on your appeal by the Board of
Veterans' Appeals.